Info-sharing between VA, DOD expands, but challenges remain

By William Jackson

Mar 13, 2009

The nation’s two largest health care providers, the Defense and Veterans Affairs departments, have been working for more than a decade to develop interoperable systems for sharing data on patients, but they still have a long way to go to achieve that goal, the Government Accountability Office told congressional panel.

The departments have developed an interface between separate data repositories and are using it to share pharmacy and drug-allergy data on more than 27,000 shared patients, an increase of 9,000 patients between June 2008 and January 2009, Valerie C. Melvin, GAO director of Information Management and Human Capital Issues said. But legacy systems at DOD and slowly emerging national standards for interoperability complicate the sharing process.

Melvin made her statements Thursday before the House Appropriations Subcommittee on Military Construction, Veterans’ Affairs and Related Agencies.

DOD and VA each provide health care services to a common pool of millions of Americans. All of VA’s patients come from DOD, and some patients are treated simultaneously in both systems. They are under a mandate set in the National Defense Authorization Act for Fiscal 2008 to establish an interoperable electronic system for handling patient records and exchanging information by the end of this fiscal year.

The initiative is important not only for the two departments, but also is seen as a pilot for a national initiative to create interoperable electronic health care records by 2014.

The sharing of fully electronic pharmacy and drug-allergy records is the greatest success the departments have had. But not all information might be susceptible to this level of sharing.

“Sharing computable data is considered the highest level of interoperability, but other levels also have value,” Melvin said. “That is, data that are only viewable still provide important information to clinicians, and much of the departments’ shared information is of this type. However, the departments have more to do: not all electronic health information is yet shared, and although VA’s health data are all captured electronically, information is still captured on paper at many DOD medical facilities.”

VA now is capturing all of its medical information electronically and has developed the Veterans Health Information Systems and Technology Architecture. “In contrast, DOD uses multiple legacy medical information systems, all of which are commercial software products that are customized for specific uses.”

A key area of progress has been in agreeing on a broad set of interoperability standards. These cover a wide range of areas, from the semantic to the technical. They are published in the Target DOD/VA Health Standards Profile, which is updated annually and contains standards established by organizations such as the Food and Drug Administration, the National Institute of Standards and Technology, and the National Library of Medicine, as well as industry and international groups.

However, federal standards for data interoperability still are emerging and the departments have been cautioned not to move ahead of this process if it is to serve as a model for a broader nationwide data-sharing effort.

The authorization act setting the Sept. 30 deadline also established a joint interagency program office to oversee the information exchange effort. The office originally was to be established in December 2008, but although a charter and organizational plan have been established, the positions of director and deputy director and other key positions have not been filled.